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Warfarin and ICH
- Warfarin causes approximately 10-15% of all intracerebral hemorrhages (ICH)
- Many warfarin-related ICHs occur with INRs in the therapeutic range
- Patients with warfarin-related ICH have higher mortality and typically suffer worse neurologic outcome
- The primary pitfall in treating patients with warfarin-related ICH is the failure to rapidly normalize the INR
- Do not delay treatment while awaiting the results of coagulation labs
- Patients should receive IV vitamin K via slow infusion and FFP
- Prothrombin Complex Concentrate (PCC) is gaining popularity but much of the supporting literature uses agents not available in the US
- Similarly, there is no significant evidence that recombinant factor VIIa improves outcomes in patients with warfarin-related ICH
References
Rincon F, Mayer SA. Clinical review: Critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008; 18:237.
Goldstein JN, Rosand J, Schwamm LH. Warfarin reversal in anticoagulant-associated intracerebral hemorrhage. Neurocrit Care2008; 9:277-83.